Claims Administrator at EmpowerFS
3 days ago
Claims Administrator
Responsibilities
- Assess claims according to the rules, benefits, and conditions of the policy and within the SLA.
- Request outstanding information from clients (telephonic & e-mail).
- Contact service providers for discounts when claims are over the company prescribed threshold.
- Ensure that all policy limitations, waiting periods, and exclusions are appropriate and in line with the policy.
- Attend to customer queries.
- Any other duties as assigned by your manager from time to time.
Skills
- Computer Literacy
Technical Competencies
- Insurance industry knowledge: Understanding of life insurance policies, funeral insurance, and relevant regulations.
- Claims processing: Familiarity with claims procedures, assessment, and settlement practices.
- Funeral industry awareness: Knowledge of funeral services, customs, and traditions.
Interpersonal and Communication Skills
- Empathy and compassion: Ability to provide sensitive support to bereaved families.
- Effective communication: Clear, concise, and respectful communication with clients, funeral homes, and other stakeholders.
- Conflict resolution: Ability to handle disputes or complaints in a professional and diplomatic manner.
Excel Analytical Skills
- Data entry: Accurate and efficient data entry for claims information, policy details, and beneficiary data.
- Data validation: Ability to validate data for accuracy, completeness, and consistency.
- Data analysis: Basic analytical skills to review and interpret claims data.
Excel Functions and Formulas
- Basic arithmetic operations: Proficiency in using basic arithmetic operations like sum, average, and count.
- Conditional logic: Understanding of IF statements and other conditional logic functions.
- Lookup and reference: Ability to use vlookup, index-match, and other look-up and reference functions.
Excel Tools and Features
- PivotTables: Basic understanding of pivot tables to summarize and analyze claims data.
- Charts and graphs: Ability to create basic charts and graphs to visualize claims data.
- Excel formulas and functions: Familiarity with other Excel formulas and functions, such as text, date, and time.
- Attention to detail: Accurate assessment and processing of claims, with attention to policy details and documentation.
- Analytical thinking: Ability to interpret policy terms, assess claim validity, and make informed decisions.
Personal Qualities
- Integrity and professionalism: Maintenance of confidentiality, impartiality, and a high level of professionalism.
- Adaptability and flexibility: Ability to work in a fast-paced environment, adapt to changing circumstances, and prioritize tasks effectively.
- Emotional resilience: Capacity to manage the emotional demands of working with bereaved families and handling sensitive or distressing situations.
Desired Education Level
- Grade 12/Matric.
- A Diploma in FAIS Compliant, RE5 Certificate or a related field can be added as an advantage.
Job Type: Full-time
Salary: Negotiable based on experience, qualifications, and current work status.
Desired Skills
- Claims Administration
Desired Work Experience
- 2 to 5 years
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